AOPA HEADLINES
BReAKING NEWS…BReAKING NEWS…BReAKING NEWS
AOPA Files Lawsuit Against Medicare
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OPA has filed suit against the U.S. Department of Health and Human Services (HHS), Medicare, in the Federal District Court for the District of Columbia. AOPA said the suit is seeking relief from the unfair and unauthorized actions of the Centers for Medicare & Medicaid Services (CMS), primarily via actions of its Recovery Audit Contractor (RAC) auditors and Durable Medical Equipment Medicare Administrative Contractors (DME MACs) relating to physician documentation requirements.
AOPA’s suit arises with respect to Medicare actions that began in August 2011 when the HHS Office of Inspector General released a report alleging fraud in the O&P industry. When the lawsuit was filed on May 13, AOPA President Thomas F. Kirk said, “Today, AOPA has stated emphatically that we will not stand by when government acts inappropriately to threaten either the quality of care we provide to our patients or the economic viability of the small businesses and providers that comprise the orthotics and prosthetics profession.” AOPA’s suit arises with respect to Medicare actions that began in August 2011 when the HHS Office of Inspector General (OIG) released a report alleging fraud in the O&P industry. According to a written statement from AOPA, the report misunderstood that patients don’t go to their physicians when their prostheses are not working properly; misunderstood that it is not unusual that most Medicare amputees may not see the referring physician who first prescribed their prosthetic care because that
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O&P Almanac JUNE 2013
physician is commonly the surgeon who amputated their limb; created extensive confusion about whether individuals with bilateral amputations should have both prostheses on a single claim or two separate claims; leapt to conclusions of fraud because claims costs had increased with a fixed number of Medicare amputee beneficiaries while failing to recognize that the Iraq and Afghanistan wars had prompted a “quantum leap in technology,” and a related incremental increase in unit cost, which together with CMS-approved O&P fee schedule increases, “after years of ‘freeze,’” had driven per capita increases; and failed to track, as required by BIPA 427, whether or not care providers were, or were not, qualified providers under federal law. AOPA alleges that CMS was in violation of the federal Administrative Procedure Act and the Medicare Act, when, in August 2011, it revised the standards by which a prosthetic claim would be judged for reimbursement approval by circulating a “Dear Physician” letter. AOPA has met with virtually every ranking official at CMS, including three meetings with the CMS Administrator. Thirty-five members of the U.S. House recently signed a letter to the Secretary of HHS seeking relief for O&P and our Medicare patients. But, despite knocking on every door, little if anything substantive has been done by Medicare to remedy this unworkable situation. Under these dire circumstances, AOPA, having exhausted all other prospects for relief, had little choice but to place this matter, and the future of the O&P profession as well as the quality of care delivered to Medicare amputee beneficiaries, in the hands of the courts. To read the full complaint, visit www.aopanet.org/ CMS/AOPAcomplaint.pdf.
Case 1:13-cv-00697-JDB AMERICAN ORTHOTIC AND PROSTHETIC ASSOCIATION, INC. v. SEBELIUS